Provider Demographics
NPI:1720065972
Name:HILLSIDE OB-GYN ASSOC INC
Entity type:Organization
Organization Name:HILLSIDE OB-GYN ASSOC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADRIAAN
Authorized Official - Middle Name:JOHAN
Authorized Official - Last Name:VAN GAALEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-866-2929
Mailing Address - Street 1:701 OSTRUM ST
Mailing Address - Street 2:STE 303
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18015-1152
Mailing Address - Country:US
Mailing Address - Phone:610-866-2929
Mailing Address - Fax:610-866-3604
Practice Address - Street 1:701 OSTRUM ST
Practice Address - Street 2:STE 303
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18015-1152
Practice Address - Country:US
Practice Address - Phone:610-866-2929
Practice Address - Fax:610-866-3604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02347000OtherBC
PA0067239OtherBS
PA0067239OtherBS